Provider Demographics
NPI:1124404975
Name:WERTMAN, DIANE R (LPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:R
Last Name:WERTMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 REESER RD
Mailing Address - Street 2:
Mailing Address - City:NEW TRIPOLI
Mailing Address - State:PA
Mailing Address - Zip Code:18066-4238
Mailing Address - Country:US
Mailing Address - Phone:484-330-1033
Mailing Address - Fax:
Practice Address - Street 1:343 S. 3RD STREET
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036
Practice Address - Country:US
Practice Address - Phone:610-282-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional